• Annals of Clinical Neurophysiology
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• v.14 no.2
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• pp.89-91
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• 2012

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.95-98
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• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Annals of Clinical Neurophysiology
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• v.19 no.1
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• pp.13-19
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• 2017

Background: Median F-wave latencies are physiologically shorter than ulnar latencies, but they are often longer relative to ulnar latencies in carpal tunnel syndrome (CTS). This study aimed to investigate the value of absolute F-waves and relative latency changes compared to ulnar latencies in the diagnosis of CTS. Methods: F-wave latencies of median and ulnar nerves in 339 hands from 339 patients with CTS and 60 hands from 60 control subjects were investigated. Mean F-wave minimal latencies of median and ulnar nerves were compared between groups. Patients were further divided into subgroups based on Canterbury grading and then analyzed using F-wave latency differences (FWLD) and F-wave ratio (FWR). Results: Of 339 hands in the CTS group, 236 hands exhibited F-wave inversion based on the FWLD criterion and 277 hands had F-wave inversion based on the FWR criterion. F-wave inversion had a sensitivity of 81.7% using the FWR criterion to diagnose CTS. The mean FWLD and FWR were significantly greater in all patient subgroups compared to the control group (p < 0.001). In addition, mean FWLD and FWR showed significant correlations (r = -0.683 and r = 0.674, respectively, p < 0.001) with disease severity. Conclusions: F-wave studies are effective supplementary diagnostic tools comparing to other standard electrophysiologic criteria for screening patients with CTS.

• Biomedical Science Letters
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• v.11 no.2
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• pp.193-199
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• 2005

The present study was performed to assess peripheral neural involvement by exposure to hand-arm vibration. Segmental sensory nerve conduction in the median and ulnar nerves were measured in shipyard workers exposed to vibration. The subjects were 47 male adults exposed to hand-arm vibration and 7 healthy male controls. The subjects underwent an extensive bilateral neurophysiological examination. Sensory compound nerve action potential (SNAP) of the median and ulnar nerves in palm-finger and wrist-palm segments were measured by antidromic method. And SNAP of the median and ulnar nerves in wrist-proximal finger and wrist-distal finger segments were measured by orthodromic method. Result of sensory nerve conduction study was abnormal in 31 patients $(66\%)$ and normal in 16 patients $(34\%)$ of subjects. The pathological pattern in the hand-arm vibration exposed group was 13 patients $(28\%)$ of carpal tunnel syndrome, 18 patients $(38\%)$ of distal sensory neuropathy, 7 patients $(15\%)$ of multifocal and 1 patient $(2\%)$ of Guyon syndrome. The present study indicates that vibration-induced nerve impairments exist both in the finger-palm and palm-wrist segment of median and ulnar sensory nerves. The results suggest that segmental sensory nerve conduction study would be useful as objective indication of peripheral nerve impairment induced by the hand-arm vibration.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.224-228
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• 2008

Ulnar nerve compression in the cubital tunnel is a common entrapment syndrome of the upper limb. Pulsed radiofrequency lesioning (PRFL) has been reported as a treatment method for relieving neuropathic pain. Since the placement of the electrode in close proximity to a targeted nerve is very important for the success of PRFL, ultrasound seems to be well suited for this technique. A 36-year-old woman presented with complaints of numbness and pain on the medial aspect of the elbow and the pain radiated down to the $4^{th}$ and $5^{th}$ fingers for 10 years after she suffered an elbow contusion, we then scheduled this woman for the ultrasound guided PRFL of the ulanr nerve. The initial ultrasound examination demonstrated a swollen nerve, loss of the fascicular pattern and an increased cross sectional area of the ulnar nerve. After confirmation of the most swollen site of the nerve via ultrasound, two sessions of PRFL were performed. The postprocedural 10 cm visual analog scale score decreased from 8 to 1 after the two sessions of PRFL.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.36-41
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• 2008

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.2
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• pp.79-83
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• 2010

Musculoskeletal ultrasonography has been used as a convenient and simple tool for diagnosis of various conditions of orthopaedic diseases for many years. Generally magnetic resonance imaging (MRI) is thought to be the best method to search for anatomical structures or variations. However, for dynamic conditions such as dislocation or subluxation of tendons and nerves, MRI is not superior to ultrasonography, especially dynamic ultrasonography. So we present such a patient with an ulnar nerve subluxation at the elbow who has symtoms mimicking cubital tunnel syndrome diagnosed by dynamic ultrasonography and treated successfully by ulnar nerve anterior transposition and think that dynamic ultrasonography is a useful method for diagnosing dynamic condition such as ulnar nerve subluxation mimicking cubital tunnel syndrome.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.128-133
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• 2008

Nerve compression is caused by external force or internal pathology, which symptom develops along nerve distribution. There are median, ulnar and radial nerve compression neuropathies below elbow. Carpal tunnel syndrome at the flexor retinaculum is most common among all the entrapment neuropathies. Other causes of median nerve neuropathy include Struther's ligament, biceps aponeurosis, pronator teres, FDS aponeurosis and aberrant muscles, which induce pronator syndrome or anterior interosseous nerve syndrome. Ulnar nerve can be compressed at the elbow by arcade of Struther, medial epicondylar groove, FCU two heads, which develops cubital tunnel syndrome, at the wrist by ganglion, fracture of hamate hook and vascular problem, which develops Guyon's canal syndrome. Radial tunnel syndrome is caused by supinator muscle, which compresses its deep branch. Treatment is conservative at initial stage like NSAID, night splint or steroid injection. If symptom persists, operative treatment should be considered after electrodiagnostic or imaging studies.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.380-382
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• 2010

The authors present an extremely rare case of a pseudoaneurysm of the ulnar artery as a complication of a two-portal endoscopic carpal tunnel release (ECTR). A 70-year-old man with chronic renal failure and on maintenance hemodialysis with a left arteriovenous fistula presented with paresthesia of his right hand. A clinical diagnosis of right carpal tunnel syndrome was confirmed by ultrasonography and an electro physiologic study. He underwent two-portal ECTR, and the paresthesia was much improved. However, he presented to us one month after operation with severe pain, a tender mass distal to the right wrist crease and more aggravation of the paresthesia in the ulnar nerve distribution. Doppler ultrasound was performed and revealed a hypo echoic lesion 20 mm in diameter in the right palm, with arterial Doppler flow inside connected to the palmar segment of the ulnar artery. An ulnar artery pseudoaneurysm was diagnosed and treated by ultrasound-guided percutaneous thrombin injection. Transverse color Doppler ultrasound image showed complete thrombosis of the pseudoaneurysm and flow cessation after a total injection of 500 units of thrombin. The symptoms were also improved.

• Journal of Preventive Medicine and Public Health
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• v.29 no.3 s.54
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• pp.507-519
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• 1996

The objectives of this study are to investigate the prevalence of occupation related carpal tunnel syndrome(CTS) among workers in a condom industry : to analyse the sensitivity and specificity of clinical signs or symptoms such as hand diagram, Tinel's sign and Phalen's sign in carpal tunnel syndrome : and to test vibration threshold test using audiometry as a technically easy and noninvasive method in the diagnosis of carpal tunnel syndrome in stead of nerve conduction velocity (NCV). The study group was divided into exposed group(39 cases) and non-exposed group(48 cases) based on whether or not excessive use of wrist movements exsist. 1. There are stastically significant differences in symptoms and signs of carpal tunnel syndrome such as hand diagram, Tinel's sign and Phalen's sign between exposed and non-exposed group(p<0.05). 2. Six cases(9 hands) were comfirmed as carpal tunnel syndrome by NCV. Five cases(7 hands) belonged to exposed group, 1 case(2 hands) to nonexposed group. As there are significant differences in prevalence of carpal tunnel syndrome between two groups(p<0.05), excessive use of wrist in occupation is a risk factor of carpal tunnel syndrome. 3. When we use NCV as a gold standard in the diagnosis of carpal tunnel syndrome, sensitivity and specificity of hand diagram, Tinel's sign and Phalen's sign is as followed; hand diagram , sensitivity 88.9%, specificity 84.2% Tinel's sign ; sensitivity 55.6%, specificity 72.8% Phalen's sign ; sensitivity 14.3%, specificity 88.4%. Among above clinical signs and symptoms, hand diagram is the best clinical screening test. 4. The differences of vibration threshold between median and ulnar nerve at the same time are useful in the diagnosis of carpal tunnel syndrome but the time change of vibration threshold of median nerve over time are not sensitive enough. It is concluded that vibration threshold between median and ulnar nerve at the same time can be used as a supplementary or alternative criterion to indicate that the nerve dysfunction is located in the carpal tunnel.